Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Saturday, December 15, 2007

A few weeks ago, I had a 50ish year old lady brought to the ED by her daughter. The chief complaint was "confusion". Mom had been confused for days. Significant medical history was denied, no medications.

History was not helpful, exam revealed a very confused somnolent patient, but was otherwise unhelpful.

The standard workup including CT scan was negative, but there was one interesting lab test. The Urine Drug Screen was almost pan-positive.

I went back to the room to ask more questions and talk to the daughter. I handed the multiply positive drug screen to the daughter and said "maybe this explains her confusion" Turns out that drug abuse had been a significant history with the patient, but they didn't tell me that part.

She woke her mother up and said "Mama, have you been doing drugs again (or "druds" if you're pretending to be a doctor...see other posts)?" The mother woke up and said......(this is my favorite part)...... "not unless they've been putting it in my weed"!

For the non-medical folks....of course the only negative part of her drug screen was the weed...the only part she admitted to! I thought it was hysterical! That case made my night all worthwhile.

i plan on living long enough to become an embarrassment to my kids and my profession. i will be the most inveterate abuser of the ER, and have every allergy in the book. the only thing that will work for me will be dilaudid. i also plan on starting to smoke pot the day my youngest heads off to college. when the ER doc asks me if i drink or use drugs i will say, "as much as i can whenever i am awake, ouch, my ding-dong hurts again, oh me! it's fixin' to making my head explode! help! help!"

there will be payback, the sins of our population will be visited upon the next generation of people silly enough to go into emergency medicine by ME. obtw, erdoc85, at that time i will hope you are still practicing. i will come and visit a lot... by ambulance every time.

emergencyem: one time as a medicine intern, I got a 4am call from one of the Sri Lankan night nurses. The patient's scrotum was "very itching". Upon further questioning this was a 2 week old problem, and "nothing worked".

This dude calls us AT LEAST twice a week...I finally got fed up one night and asked him, "just what do you want us to do about this?" He looked at me blankly then said, "scratch it?" I replied, "I dont think so, get in the ambulance."

The next time I said, "well hell, why don't you scratch it?" He flipped me off. Yea.

He doesn't have heating in his house...so I suspect when it gets really cold we'll be picking him up every night...is there a law against abusing 911?

Etotheipi: Be very careful dude...you just made a clinically significant remark! That was my recommendations too...that someone add some weed to her crank and she'd be all better!

Emergencyem: no laws. It's not about abuse of the EMS, it's about lawyers. Imagine one time if you fail to transport this dude and he suffers acute spontaneous bilateral nippoplosions. He'd be all over 20/20 and the "uncaring" medical establishment would again be blamed for societies' ills. Hillary would surely be interviewed. Seriously, though,if your medical director had any balls (in my experience, few do), he could arrange a protocol by where you don't have to transport this guy every time.

+20 for that comment. +5 for saying Hillary would be involved. Very funny!

Yea...our director won't write refusing transports into our protocols...he's a pussy...of course the gig with the itchy nipple guy is waaaay backwoods ems...at my other job we have a protocol in place to where we wouldn't have to transport his sorry ass...sorry I'm angry. I just got back from picking him up. Again.

other than that we would be the guys snapping towels at your ass in the locker room. 911, I have to admit that whenever a guy saw my ass, snapping it never entered into the conversation.

Lynn: I expect to read about nippoplisions in your next book. Since my writing is based on reality, I'm going to search far and wide to find such a case. I'm depending on you guys to help me out. Oh. Wait. Then I gotta dedicate the book to you. Yeah...I can do that.

All this talk about weed reminds of the old days when PCP was still a big player on the street and people came in all "wacked out". (Now U know how old I really am!) Never understood why they wanted to ruin the buzz and mellow of their pot!